中华护理杂志 ›› 2022, Vol. 57 ›› Issue (24): 3038-3045.DOI: 10.3761/j.issn.0254-1769.2022.24.016
舒越(), 毕蒙蒙, 张超(), 龚艳艳, 李智欣, 周甜甜, 李星茹, 刘晓玉, 谢文广
收稿日期:
2022-03-25
出版日期:
2022-12-20
发布日期:
2022-12-23
通讯作者:
张超,E-mail:931048874@qq.com作者简介:
舒越:女,本科(硕士在读),E-mail:543349468@qq.com
基金资助:
SHU Yue(), BI Mengmeng, ZHANG Chao(), GONG Yanyan, LI Zhixin, ZHOU Tiantian, LI Xingru, LIU Xiaoyu, XIE Wenguang
Received:
2022-03-25
Online:
2022-12-20
Published:
2022-12-23
摘要:
目的 检索、评价并总结国内外关于ICU患者人工气道气囊管理的最佳证据,为临床实践与标准制订提供参考。 方法 系统检索UpToDate、BMJ Best Practice、国际指南协作网、美国国立指南网、澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心数据库、Cochrane Library、PubMed、Embase、Web of Science、CINAHL、英国国家卫生与临床优化研究所网站、中国临床指南文库、医脉通、万方数据库、中国生物医学文献数据库、中国知网关于ICU患者人工气道气囊管理的所有证据,包括临床决策、指南、系统评价及专家共识等。检索时限为2012年1月—2022年2月。由4名研究者对纳入的文献质量进行评价,2名研究者对符合质量标准的文献进行证据提取。 结果 共纳入22篇文献,其中临床决策3篇、指南7篇、专家共识3篇、系统评价9篇。总结出29条最佳证据,包括人工气道评估、气囊的选择、气囊充气方法、气囊充气时机、气囊压力调节、气囊漏气评估、气囊上滞留物的清除、气囊漏气试验8个方面。 结论 ICU患者人工气道气囊管理的最佳证据可为临床医护人员提供循证证据,以科学的方法管理人工气道气囊,有助于降低ICU患者呼吸机相关性肺炎的发生率。
舒越, 毕蒙蒙, 张超, 龚艳艳, 李智欣, 周甜甜, 李星茹, 刘晓玉, 谢文广. ICU患者人工气道气囊管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(24): 3038-3045.
SHU Yue, BI Mengmeng, ZHANG Chao, GONG Yanyan, LI Zhixin, ZHOU Tiantian, LI Xingru, LIU Xiaoyu, XIE Wenguang. Summary of the best evidence of artificial airway endotracheal tube cuff management in ICU adult patients[J]. Chinese Journal of Nursing, 2022, 57(24): 3038-3045.
[1] | 中华医学会呼吸病学分会呼吸治疗学组. 人工气道气囊的管理专家共识(草案)[J]. 中华结核和呼吸杂志, 2014, 37(11):816-819. |
Respiratory Therapy Group of Chinese Thoracic Society. Expert consensus on the management of artificial airway airbag (draft)[J]. Chin J Tuberc Respir Dis, 2014, 37(11):816-819. | |
[2] |
吴彦烁, 尹彦玲, 高鹏, 等. 1例人工气道气囊多次破裂的急救与护理[J]. 中华护理杂志, 2020, 55(5):766-768.
DOI |
Wu YS, Yin YL, Gao P, et al. First aid and nursing of a patient with multiple rupture of endotracheal cuff[J]. Chin J Nurs, 2020, 55(5):766-768. | |
[3] | Sultan P, Carvalho B, Rose BO, et al. Endotracheal tube cuff pressure monitoring:a review of the evidence[J]. J Perioper Pract, 2011, 21(11):379-386. |
[4] | Hyzy RC. Complications of the endotracheal tube following initial placement:prevention and management in adult intensive care unit patients[EB/OL].(2021-10-19)[2022-03-02]. https://www.uptodate.com/contents/complications-of-the-endotracheal-tube-following-initial-placement-prevention-and-management-in-adult-in-tensive-care-unit-patients?search=Ventilator-associated%20pneumonia&source=search_result&selectedTitle=11-145&usage_type=default&display_rank=11. |
[5] | 施毅. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J]. 中华结核和呼吸杂志, 2018, 41(4):255-280. |
Shi Y. Guidelines for diagnosis and treatment of adult hospital-acquired pneumonia and ventilator-associated pneumonia in adults in China(2018 edition)[J]. Chin J Tuberc Respir Dis, 2018, 41(4):255-280. | |
[6] | 中华医学会重症医学分会. 呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J]. 中华内科杂志, 2013, 52(6):524-543. |
Chinese Society of Critical Care Medicine. Guidelines for diagnosis,prevention,and treatment of ventilator-associated pneumonia(2013)[J]. Chin J Intern Med, 2013, 52(6):524-543. | |
[7] |
Maertens B, Blot K, Blot S. Prevention of ventilator-associated and early postoperative pneumonia through tapered endotracheal tube cuffs:a systematic review and meta-analysis of randomized controlled trials[J]. Crit Care Med, 2018, 46(2):316-323.
DOI PMID |
[8] |
Pozuelo-Carrascosa DP, Herráiz-Adillo á, Alvarez-Bueno C, et al. Subglottic secretion drainage for preventing ventilator-associated pneumonia:an overview of systematic reviews and an updated meta-analysis[J]. Eur Respir Rev, 2020, 29(155):190107.
DOI URL |
[9] |
Blot SI, Rello J, Koulenti D. The value of polyurethane-cuffed endotracheal tubes to reduce microaspiration and intubation-related pneumonia:a systematic review of laboratory and clinical studies[J]. Crit Care, 2016, 20(1):203.
DOI URL |
[10] | Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist:a tool to improve reporting of clinical practice guidelines[J]. BMJ, 2016, 352:i1152. |
[11] |
董珊, 袁玲, 陈秋菊, 等. 肠造口周围潮湿相关性皮肤损伤预防与管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(2):223-230.
DOI |
Dong S, Yuan L, Chen QJ, et al. Summary of the best evidence for the prevention and management of peristomal moisture-associated skin damage in adults[J]. Chin J Nurs, 2022, 57(2):223-230.
DOI |
|
[12] | 顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703. |
Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research——the quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):701-703. | |
[13] |
穆文方, 王娴, 肖星婷, 等. 下肢静脉溃疡患者自我管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(6):740-748.
DOI |
Mu WF, Wang X, Xiao XT, et al. Summary of the best evidence for self-management in patients with venous leg ulcer[J]. Chin J Nurs, 2022, 57(6):740-748.
DOI |
|
[14] | 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967. |
Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967. | |
[15] | Klompas M. Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults[EB/OL]. (2021-09-10)[2022-03-05]. https://www.uptodate.com/contents/zh-Hans/risk-factors-and-prevention-of-hospital-acquired-and-ventilator-as-sociated-pneumonia-in-adults?search=Ventilator-associated%20-pneumonia&source=search_result&selectedTitle=3-94&usage_ type=default&display_rank=3. |
[16] | Hyzy RC. Extubation management in the adult intensive care unit[EB/OL].(2022-02-28)[2022-03-10]. https://www.uptodate.com/contents/extubation-management-in-the-adult-intensive-care-unit search=Ventilator-associated%20pneumonia&source=sear-ch_result&selectedTitle=25-145&usage_type=default&display_ rank=25. |
[17] |
Girard TD, Alhazzani W, Kress JP, et al. An official American Thoracic Society/American College of chest physicians clinical practice guideline:liberation from mechanical ventilation in critically ill adults. Rehabilitation protocols,ventilator liberation protocols,and cuff leak tests[J]. Am J Respir Crit Care Med, 2017, 195(1):120-133.
DOI URL |
[18] |
Ahmad I, El-Boghdadly K, Bhagrath R, et al. Difficult Airway Society guidelines for awake tracheal intubation(ATI) in adults[J]. Anaesthesia, 2020, 75(4):509-528.
DOI PMID |
[19] |
Higgs A, McGrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults[J]. Br J Anaesth, 2018, 120(2):323-352.
DOI PMID |
[20] | National Institute for Health and Care Excellence(NICE). PneuX to prevent ventilator-associated pneumonia[EB/OL].(2021-04-30)[2022-03-02]. https://www.nice.org.uk/guidance/mtg48. |
[21] | Klompas M, Branson R, Eichenwald EC, et al. Strategies to pre-vent ventilator-associated pneumonia in acute care hospitals:2014 update[J]. Infect Control Hosp Epidemiol, 2014, 35(Suppl 2):S133-S154. |
[22] |
Trouillet JL, Collange O, Belafia F, et al. Tracheotomy in the intensive care unit:guidelines from a French expert panel[J]. Ann Intensive Care, 2018, 8(1):1-15.
DOI PMID |
[23] | Law JA, Duggan LV, Asselin M, et al. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway:part 2. Planning and implementing safe management of the patient with an anticipated difficult airway[J]. J Can D’anesthesie, 2021, 68(9):1405-1436. |
[24] | 中华医学会神经外科学分会, 中国神经外科重症管理协作组. 中国神经外科重症患者气道管理专家共识(2016)[J]. 中华医学杂志, 2016, 96(21):1639-1642. |
Neurosurgery Branch of Chinese Medical Association,China Neurosurgery Critical Care Management Cooperation Group. Expert consensus on airway management of critical patients in neurosurgery in China(2016)[J]. Natl Med J China, 2016, 96(21):1639-1642. | |
[25] | Wen ZJ, Zhang HY, Ding JP, et al. Continuous versus intermittent subglottic secretion drainage to prevent ventilator-associated pneumonia:a systematic review[J]. Crit Care Nurse, 2017, 37(5):e10-e17. |
[26] |
Hockey CA, van Zundert AA, Paratz JD. Does objective measurement of tracheal tube cuff pressures minimise adverse effects and maintain accurate cuff pressures? A systematic review and meta-analysis[J]. Anaesth Intensive Care, 2016, 44(5):560-570.
DOI URL |
[27] |
Delorenzo AJ, Shepherd M, Jennings PA. Endotracheal cuff pre-ssure changes during helicopter transport:a systematic review[J]. Air Med J, 2017, 36(2):81-84.
DOI PMID |
[28] |
Wen ZJ, Wei L, Chen JY, et al. Is continuous better than intermittent control of tracheal cuff pressure? A meta-analysis[J]. Nurs Crit Care, 2019, 24(2):76-82.
DOI PMID |
[29] |
Kuriyama A, Jackson JL, Jun KM. Performance of the cuff leak test in adults in predicting post-extubation airway complications:a systematic review and meta-analysis[J]. Crit Care, 2020, 24(1):640.
DOI URL |
[30] |
Kuriyama A, Umakoshi N, Sun R. Prophylactic corticosteroids for prevention of postextubation stridor and reintubation in adults:a systematic review and meta-analysis[J]. Chest, 2017, 151(5):1002-1010.
DOI PMID |
[31] |
Marjanovic N, Boisson M, Asehnoune K, et al. Continuous pneu-matic regulation of tracheal cuff pressure to decrease ventilator-associated pneumonia in trauma patients who were mechanically ventilated:the AGATE multicenter randomized controlled study[J]. Chest, 2021, 160(2):499-508.
DOI PMID |
[32] | 吴彦烁, 宿桂霞, 尹彦玲, 等. 4种临床因素对人工气道气囊压力的影响[J]. 中华护理杂志, 2017, 52(8):934-937. |
Wu YS, Su GX, Yin YL, et al. The effects of 4 different clinical factors on endotracheal cuff pressure[J]. Chin J Nurs, 2017, 52(8):934-937. | |
[33] |
Weston Smith N, Spivey M. Promoting subglottic secretion drai-nage:a quality improvement project in a UK critical care unit[J]. BMJ Open Qual, 2021, 10(2):e001269.
DOI URL |
[34] | 樊华, 宋瑰琦, 陈霞, 等. 两种气流冲击法对清除气管插管气囊上滞留物的效果研究[J]. 中华护理杂志, 2018, 53(5):553-557. |
Fan H, Song GQ, Chen X, et al. Effects of two air-impact me-thods on clearing subglottic secretions in patients with tracheal intubation[J]. Chin J Nurs, 2018, 53(5):553-557. |
[1] | 胡丽莎, 彭红华, 米元元, 曹咪, 胡敏, 祝玲, 喻红君, 彭淑华. 肿瘤靶向治疗患者皮肤不良反应预防及管理的证据总结[J]. 中华护理杂志, 2022, 57(9): 1061-1069. |
[2] | 孙倩倩, 叶红芳, 杨莉. 接纳与承诺疗法对乳腺癌患者干预效果的Meta分析[J]. 中华护理杂志, 2022, 57(9): 1070-1078. |
[3] | 周红琴, 陈秀萍, 诸纪华, 夏姗姗, 金陈娣, 盛美君, 罗飞翔, 谢王芳, 左泽兰, 胡静, 刘丽丽, 浦凯. 儿科ICU护士对每日唤醒患儿的知信行现状调查[J]. 中华护理杂志, 2022, 57(9): 1100-1104. |
[4] | 张晓梅, 秦毅, 陈瑜, 王伶俐, 李静逸, 王娅. 经中心静脉通路装置采血的最佳证据总结[J]. 中华护理杂志, 2022, 57(9): 1134-1140. |
[5] | 刘美华, 彭剑雄, 罗翠, 郑焱, 朱丽辉, 肖政辉, 张新萍, 李庆博, 熊亮. 机械通气患儿早期活动方案的构建及应用研究[J]. 中华护理杂志, 2022, 57(8): 901-907. |
[6] | 任宣霖, 樊落, 田金徽, 朱伟, 郝雅茹. ICU气管插管患者拔管指南的质量评价与内容分析[J]. 中华护理杂志, 2022, 57(8): 1001-1007. |
[7] | 全殷殷, 张帅, 陈娟红, 刘飞跃, 姚惠萍. ICU患者早期肠内营养耐受性监测系统的构建与应用[J]. 中华护理杂志, 2022, 57(7): 773-778. |
[8] | 王庆云, 肖素飞, 卢嫦清, 何军, 周姓良. 连续性肾脏替代治疗嵌入体外膜肺氧合管路连接方式的研究进展[J]. 中华护理杂志, 2022, 57(7): 811-815. |
[9] | 陈一媛, 林敏, 黄美春, 张奕馨, 许晓宇, 林丹丹, 庄耀宁. 福建省ICU护士对呼吸机相关性膈肌功能障碍护理知信行的现状调查[J]. 中华护理杂志, 2022, 57(7): 841-845. |
[10] | 古钰君, 张国增, 冯宪凌, 白杨, 岳岚, 王梦. 癌症患者化疗所致脱发心理体验质性研究的Meta整合[J]. 中华护理杂志, 2022, 57(7): 872-879. |
[11] | 穆文方, 王娴, 肖星婷, 王燕, 许志玮. 下肢静脉溃疡患者自我管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(6): 740-747. |
[12] | 王刚, 潘月帅, 孟艳雷, 林辉, 王蕊, 万香玉, 魏丽丽. ICU患者血液净化专用中心静脉导管封管情况的调查[J]. 中华护理杂志, 2022, 57(5): 525-531. |
[13] | 毛越, 徐剑锋, 李梅, 朱蓓蓓, 杨丹燕, 莫权峰, 何杰. 经导管主动脉瓣置换术患者Ⅰ期心脏康复的最佳证据应用[J]. 中华护理杂志, 2022, 57(5): 563-568. |
[14] | 孙闽闽, 吴娟, 李文霞, 王逸楠, 王莉. 心肌梗死患者出院后重返社会体验质性研究的Meta整合[J]. 中华护理杂志, 2022, 57(4): 415-423. |
[15] | 林楠, 诸纪华, 徐红贞, 周红琴. 早产儿体位管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(4): 486-492. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||